Immune Privilege May Predispose Patients after Orthotopic Heart Transplantation to Develop Recipient to Donor Atrial Connections Associated with Atrial Arrhythmias
1Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, 2Heart and Vascular Institute, Pennsylvania State University, Hershey, PA, 3Tampa General Hospital, Tampa, FL
Meeting: 2019 American Transplant Congress
Abstract number: B106
Keywords: Anastomatic healing, Heart transplant patients
Session Information
Session Name: Poster Session B: Heart and VADs: All Topics
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: The formation of functional electrical inter-atrial connections (IAC) between recipient and donor atria after orthotopic heart transplantation (OHT) is intriguing and its mechanism is poorly understood. It is reasonable to believe that cell to cell coupling between immunologically mismatched graft and host could be jeopardized by local rejection and inflammation. We sought to investigate if indices of immune mismatch or privilege were predictive of IAC.
*Methods: We retrospectively reviewed medical records of 37 consecutive OHT recipients who underwent catheter ablation for atrial tachyarrhythmias at our institution from 2005-2018. Electrophysiological reports and immunological parameters were reviewed.
*Results: Recipient to donor IAC were found in 8/37 patients (22%), and were right-sided in 4 patients (with bi-atrial anastomosis) and left-sided in 4 patients. In all patients with IAC, clinical tachycardia originated from recipient atrium and propagated through the IAC to the donor atrium. Two patients with left-sided IAC had atrial fibrillation. In patients without IAC, tachycardia originated from the donor atrium. Time from OHT to ablation procedure of IAC was highly variable and ranged from 0.25 to 19 years. Donor specific antibodies (DSAB) were not present in patients with IAC and present in 55% of patients without IAC (p=0.03).
*Conclusions: Functional electrical recipient to donor IAC were found in 22% of patients with atrial tachyarrhythmias. Their prevalence in asymptomatic patients with OHT is unknown. IAC can be manifest very early after OHT. Immune privilege characterized by absence of DSAB may facilitate formation of IAC that can expose the donor atria to tachycardias originated in the remnant recipient atrial chambers.
| Variables (ns = non-significant) | IAC(n=8) | No IAC(n=29) | p-value |
| Male/Female Age (years) |
4/4 60 ± 14 |
22/7 54 ± 16 |
0.15 ns |
| Time from OHT to Ablation (years) | 9.8 ± 6.2 | 9.9 ± 6.2 | ns |
| Bi-atrial/Bi-caval Anastomosis | 4/4 | 17/12 | ns |
| DSAB (+/-) | 0/8 | 16/13 | 0.03 |
| Vasculopathy (+/-) | 2/6 | 10/19 | ns |
| PRA Pre-ablation (+/-) PRA Post-ablation (+/-) |
0/7 0/7 |
4/16 3/14 |
ns ns |
| Peak Biopsy Grade 1st Year Peak Biopsy Grade After 1st Year Biopsy Score |
1.67 ± 0.82 1.0 ± 0.7 0.28 ± 0.11 |
1.67 ± 0.78 1.5 ± 0.5 0.27 ± 0.16 |
ns 0.14 ns |
To cite this abstract in AMA style:
Herweg B, Nellaiyappan M, Tran T, Mabry G, Weston K, Eisen HJ, Weston M. Immune Privilege May Predispose Patients after Orthotopic Heart Transplantation to Develop Recipient to Donor Atrial Connections Associated with Atrial Arrhythmias [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/immune-privilege-may-predispose-patients-after-orthotopic-heart-transplantation-to-develop-recipient-to-donor-atrial-connections-associated-with-atrial-arrhythmias/. Accessed May 18, 2025.« Back to 2019 American Transplant Congress